| NPI | 1740459577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 001018) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN LMT 0000000642) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2026-07-10 |